某院85例万古霉素血药浓度监测结果分析及药学监护

目的:分析万古霉素血药浓度监测情况,为临床合理用药提供依据,充分体现临床药师在药学监护中的重要作用。方法:采用化学发光微粒免疫检测法(吖啶酯)测定万古霉素血药浓度,对我院2012年66例患者85例次万古霉素血药浓度监测结果及用药合理性进行回顾性总结和分析。结果:从年龄结构上看,万古霉素的患者以老年患者居多,>60岁的患者占54.55%;血清万古霉素谷浓度在治疗窗范围内的占48.24%,超过一半的患者血药浓度不在治疗窗内,其中达到中毒浓度(超过20 mg·L^-1)的患者高达20%。肾功能正常组及肾功能损害组用药前后的血肌酐及尿素氮无统计学差异,但肾功能轻度损害组较正常组平均血药浓度存在显著性差异;分析采用同一给药方案(1.0 g,q12 h)时,肾功能正常及轻度损害患者,超过治疗窗上限的比例不高,但肾功能严重损害的患者万古霉素中毒发生率明显增加;此外,肌酐清除率相当的患者,万古霉素谷浓度也存在明显的差异。结论:万古霉素血药浓度个体差异较大,应加强万古霉素血药浓度的监测,特别是对于老年及肾功能损害患者的用药监护,包括治疗效果评估、动态监测肾功能指标等,实现个体化用药,保证临床医生用药的安全有效。

Analysis of serum vancomycin concentration monitoring and pharmaceutical care in 85 cases

OBJECTIVE To analyze serum vancomycin concentrations to provide a basis for clinical rational drug use, and fully embody importance of clinical pharmacists in pharmaceutical care.METHODS Chemiluminescent microparticle immunoassay (acridinium) was used to determine vancomycin concentrations for 85 cases of 66 patients in our hospital in 2012, and summarize results of concentration monitoring and analysis of medication rationality retrospectively.RESULTS From age structure, it could been seen that most patients with vancomycin trough concentration in our hospital were elderly patients, and patients older than 60 years accounted for 54.55%. Vancomycin trough concentrations within therapeutic scope accounted for 48.24%, so more than a half was not within therapeutic scope. Twenty percent of patients reached the toxic concentrations of higher than 20 mg·L^-1. Comparison of creatinine and urea nitrogen before and after treatment showed no significant difference between patients with normal and impaired renal functions. However, average vancomycin trough concentration for patients with mild renal damage was significantly different from than in normal patients. For patients with normal renal function and mild damage, when the same dosing regimen (1.0 g q12 h) was administered, percentage of values beyond the upper limit of therapeutic scope was not high. But for patients with severe renal damage, incidence of vancomycin intoxication increased. Moreover, vancomycin trough concentrations were obviously different between similar creatinine clearance rates.CONCLUSION Due to large individual difference of serum vancomycin concentrations, serum vancomycin concentration monitoring should be enhanced especially for elderly patients or patients with renal dysfunction. Pharmaceutical care should include assessment of therapeutic effects, dynamic monitoring of renal function, etc. to achieve individualized medication, ensure safety and efficacy of medication.